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At the end of 2016, the Scottish Government published a 38 page national delivery plan to up the pace of improvement and change within Scotland’s health and care system. NHS boards are required to set out their contributions to driving this forward in their Local Delivery Plans for 2017/18.
The overall aim is a health and social care system that is integrated; focuses on prevention, anticipation and supported self-management; makes day-case treatment the norm; puts the person at the centre of all decisions; and ensures hospitalised people get back into their home as soon as appropriate.
All of that is consistent with the NHS goals currently being advanced in England through Sustainability and Transformation Plans (STPs). Where the STP process focuses strongly on savings requirements, however, the Scottish framework does not (though there are financial pressures and performance problems, as highlighted by National Audit Scotland’s recent report).
The Health and Social Care Delivery Plan concentrates on areas of improvement on the back of £128m of change funding in 2017-18. The report doesn’t set out specific funding commitments, as these will be contained in ‘a financial plan which will support this delivery plan’, and it is recognised that this will need to ‘put in place arrangements to support sustainable financial balance’ and ‘create short-term financial capacity to allow time to deliver change through efficiencies in current ways of working’.
To turn that vision into reality requires that concrete actions are identified under the key headings of integration, clinical strategy and public health improvement (as well as plans to consider NHS Board reform, and some cross-cutting actions).
Scotland is already more integrated than England, as there are 14 NHS boards, 32 local authorities, with a single commissioning body (Integrated Joint Board (IJB)) managing the budget for health and social care. In order to push on in that context, action is centred on three key areas: reducing inappropriate use of hospital services; shifting resources to primary and community care; and supporting the capacity of community care.